therapeutic manoeuvres
Last reviewed 01/2018
Therapeutic manoeuvres during ERCP include:
- gallstone removal with sphincterotomy:
- a basket or balloon permits the removal of stones up to 2 cm in diameter
- the bile duct can be cleared in 80% of patients
- sphincterotomy enlarges the lumen of the ampulla and facilitates the spontaneous passage of gallstones
- dilatation of benign biliary strictures
- stenting:
- indicated for palliation of bile obstruction in malignant disease
- stenting involves the passage of a guide wire, followed by a cannula
- the stent is 'railroaded' over the cannula
- symptoms such as pruritus usually resolve within 12 hr but jaundice takes longer to improve
- plastic stents become clogged with bilirubin pigment and may need changing after an average of 4 months; expensive, self-expanding metal stents probably last longer
- stenting is successful in about 70% of patients with cancer of the head of the pancreas, where an open operation previously had a 10-30% mortality within 30 days of surgery